The subject application relates to a healthcare payment system that prevents patient fraud and merges healthcare banking (e.g., a health savings account, etc.) website information with healthcare insurance website information to facilitate payment to a healthcare provider while adjudicating the payment. While the described systems and methods relate to healthcare payments, it will be appreciated that the described features and aspects may find application in other payment systems or methods, other healthcare information systems, and the like.
Conventional healthcare payment systems involving a health savings account (HSA) or an health reimbursement account (HRA) employ a debit card system, whereby a patient visits a healthcare provider (e.g., a doctor, a registered nurse practitioner, a clinic, etc.) and upon leaving, pays all or a portion of the bill for the visit via the debit card. However, a drawback of such systems is that patients don't always know what to pay or can easily abuse the system by using their medical funds for other goods and services other than the required goods or services allowed by law. Healthcare fraud now amounts to over 150 billion dollars a year in the United States. For instance, a covered member can buy non-health related items as long as they check out at the pharmacy swipe machine, which is configured in the credit card system as a pharmacy. This would then allow the misuse of the medical funds in an HSA account or other type of medical account. Another type of fraud can be perpetrated when, for example, an aunt fraudulently takes her niece or nephew to see a doctor, while claiming that the niece or nephew is actually her child and therefore covered by her family health insurance plan. This type of fraud occurs quite frequently because there are few if any measures by which a healthcare provider can verify the identity of a child brought in by an adult, or even that the adult is using a friend's or another person's health card to seek care.
Another type of fraud that frequently occurs with health savings accounts occurs at the pharmacy counter in a drug store or the like. Many HSAs permit patients to purchase over-the-counter health-related items (e.g., cough medicine, anti-itch creams, etc.) using funds in the HSA, and these purchases are applied to the patient's annual deductible. However, a dishonest patient's often attempt to purchase non-medical items in this manner. For instance, a patient may approach the pharmacy counter with a bottle of cough medicine and a candy bar, and attempt to pay for both using his HSA debit card. Even if the teller at the pharmacy counter notices that the patient is using and HSA debit card to buy the candy bar and informs the patient that the candy bar does not qualify as a health-related expense, the patient may merely argue that he is diabetic and therefore the candy bar is medically qualified as a purchase. In any case, this sort of fraud is common and results in increased healthcare costs for all patients.
Another type of fraud occurs when the medical provider submits claims that are fraudulent without the knowledge of the medical card holder.
Accordingly, there is an unmet need for systems and/or methods that facilitate overcoming the aforementioned deficiencies.